Better renal function with enhanced immunosuppression and protocol biopsies after kidney transplantation in children

Subclinical rejection may be associated with decreased graft function after renal transplantation (Tx). Detection by protocol biopsies and treatment could thus be important for the long-term prognosis. We have earlier discovered that glomerular filtration rate (GFR) declined in young children during the first 18 months. Consequently, we slightly enhanced and individualized each patient's immunosuppression. This was a retrospective study of 59 pediatric renal Tx patients between 1995 and 2001. The 35 historical controls received triple-therapy of azathioprine, methylprednisolone and cyclosporine. GFR was measured by protocol at discharge, 6 and 18 months, and a core biopsy was obtained at 18 months. The 24 study patients in addition received basiliximab, had GFR measured at 3 and 12 months, and a biopsy taken at 3 months. Based on histology and function, immunosuppression was individually adjusted. The groups were compared for GFR and histology at 18 months after Tx. There were less acute rejection episodes in the study group (0.38 vs. 1.23 per patient) and serum creatinine concentrations were lower. Subclinical rejection was detected and treated in 39% at 3 months. There were more chronic changes in the control (47%) than in the study group (29%) at 18 months. GFR was significantly higher in the study group at 18 months (87 vs. 68 mL/min/1.73 m(2)), most remarkably in patients < or =2 yr of age (99 vs. 68 mL/min/1.73 m(2)). Detection of subclinical rejection and slightly enhanced and individualized immunosuppression improved GFR 18 months after renal Tx, especially in the youngest patients.     

Evaluation of the MDHAQ in Finnish patients with RA [corrected

OBJECTIVE: To study the characteristics of the Multidimensional Health Assessment Questionnaire (MDHAQ) in Finnish patients with rheumatoid arthritis. METHODS: The reliability of the questionnaire was tested by test-retest procedure. Construct validity was studied by factor analysis and convergent validity by calculating correlations between the Finnish MDHAQ (Finn-MDHAQ) scales and the Finnish Health Assessment Questionnaire (HAQ) and the Finnish Arthritis Impact Measurement Scales (Finn-AIMS2). Correlations between Finn-MDHAQ and measures of clinical characteristics, disease activity, and functional class were also measured. An item analysis was made of the Finn-MDHAQ scales Function (FN) and Psychological (PS). RESULTS: Internal consistency on the FN scale was 0.92 (95% lower limit 0.89) and 0.66 (0.56) on the PS scale. Reproducibility (95% CI) on FN was 0.93 (0.82 to 0.97) and on PS 0.84 (0.70 to 0.92). Factor analysis identified 2 factors, mobility of upper extremities and trunk, and mobility of lower extremities. Strong correlations were found between the FN scale and HAQ and physical subscales of Finn-AIMS2 and between PS and the psychological subscales of Finn-AIMS2. In item analysis corrected item correlation was high on the Finn-MDHAQ scales, except in one item on the PS scale. CONCLUSION: The Finn-MDHAQ is an applicable, reliable, and valid instrument for the part of the FN scale measuring functional ability in Finnish rheumatic patients. The incongruity in the PS scale structure that produced moderate internal consistency can be overcome with minor modifications.     

Psychiatric drug trials and placebo

The placebo-controlled trial has been the standard method to demonstrate efficacy and safety of drugs. The trials are regulated by standards and principles that aim to safeguard patient safety and to ensure the faultless availability of reliable information about the object of the survey. The use of a placebo group in clinical drug trials is still as well founded as ever, and is especially important in conditions where the severity of the disorder is associated with variation in time, the possibility of a spontaneous recovery, or in conditions involving a significant proportion of subjective experience. In this systematic review, the present guidelines for developing new compounds for psychiatric disorders are discussed.     

Quantitative electroencephalographic measures in homicidal men with antisocial personality disorder

Many symptoms of antisocial personality disorder have been proposed to be related to decreased daytime vigilance. To explore this hypothesis, quantitative analyses were conducted of the electroencephalographic (EEG) activity of drug-free and detoxified homicidal male offenders with antisocial personality disorder as the primary diagnosis. Subjects comprised 16 men recruited from a forensic psychiatric examination in a special ward of a university psychiatric hospital. Fifteen healthy age- and gender-matched controls with no criminal record or history of physical violence consisted of hospital staff and students. An overall reduction of alpha power was observed in the waking EEG of offenders. A bilateral increase in occipital delta and theta power was also found in these individuals. This study provides further support to the growing evidence of brain dysfunction in severe aggressive behavior. Homicidal offenders with antisocial personality disorder seem to have difficulties in maintaining normal daytime arousal. Decreased vigilance, together with social and psychological variables, may explain their aberrant behavior in everyday life. New studies are, however, needed to specify the vigilance problems of this patient group.     

Laparoscopy in chronic abdominal pain: a prospective nonrandomized long-term follow-up study

GOAL: Our aim was to assess the long-term efficacy of diagnostic laparoscopy and adhesiolysis on the treatment of intractable chronic abdominal pain. STUDY: This was a prospective nonrandomized study of 72 patients (60 women and 12 men). One surgeon performed a total of 79 diagnostic laparoscopies including 61 adhesiolysis. The patients' demographic data, operative findings, and long-term postoperative course were carefully recorded. A quality-of-life questionnaire was mailed after the mean follow-up of 3.7 years to find out the late course of any chronic abdominal symptoms after the surgery. RESULTS: Intra-abdominal adhesions were found in 61 patients (85%) in the laparoscopy, gynecologic disorders in 4, chronic appendicitis in 1, and no abnormality in 6 patients. The abdominal wall pain was a likely reason for pain in 12 patients (17%). The complication rate was minimal, including only four bleedings (one major), one perforation of urinary bladder, and three wound infections. At 1-month control, 38% of the patients were completely free of pain. In the long-term follow-up, chronic abdominal pain was totally healed in 33%, diminished in 46%, and unchanged in 21% of the patients. A total of 65 patients (90%) reported that the surgery had been beneficial for their intractable pain. CONCLUSIONS: By careful selection, for patients with chronic abdominal pain, laparoscopy alleviates the symptoms in more than 70% of the patients, and it should be considered if other diagnostics tests are negative. A placebo-controlled study is needed, in which the patients are randomized into laparoscopy and conservatively treated groups with a quality-of-life measurement.     

Allergic rhinitis and pharmacological management in elite athletes

INTRODUCTION: Only a few studies have examined the occurrence of atopy and clinically apparent allergic disease and their pharmacological management in elite athletes. The aim of the study was to assess the frequency of allergic rhinitis and the use of antiallergic medication within the subgroups of elite athletes as compared with a representative sample of young adults of the same age. METHODS: A cross-sectional survey was carried out in 2002. All the athletes (N = 494) financially supported by the National Olympic Committee comprised the study group. Of them, 446 (90.3%) filled in a structured questionnaire concerning asthma and allergies, the use of medication, characteristics of sport activities, and smoking habits. A representative sample of Finnish young adults (N = 1504) served as controls. RESULTS: The endurance athletes reported physician-diagnosed allergic rhinitis more often (36.1%) than other athletes (23.4%) or control subjects (20.2%). The use of antiallergic medication was reported by 33.3, 15.7, and 15.6% of those, respectively. Among both athletes and controls, females reported the use of antiallergic medication more often than males. Only half of those athletes reporting allergic rhinitis had used antiallergic medication during the past year. After adjusting for age and sex, OR (95% CI) for allergic rhinitis and the use of antiallergic medication were 2.24 (1.48-3.39) and 2.79 (1.82-4.28), respectively, in endurance athletes as compared with the controls. CONCLUSIONS: Endurance athletes have physician-diagnosed allergic rhinitis, and they use antiallergic medication more often than athletes in other events or control subjects. Only half of those athletes reporting allergic rhinitis take antiallergic medication. More attention needs to be paid to the optimal management of allergic rhinitis, especially in highly trained endurance athletes.     

Arthroscopic cartilage indentation and cartilage lesions of anterior cruciate ligament-deficient knees

BACKGROUND: The anterior cruciate ligament-deficient knee is prone to osteoarthritis and meniscus lesions. Very little, however, is known about the biomechanical properties of articular cartilage in anterior cruciate ligament-deficient knees. PURPOSE: To evaluate biomechanical and macroscopical cartilage changes in the knee joint with respect to the time after anterior cruciate ligament rupture. HYPOTHESIS: Chronic anterior cruciate ligament deficiency induces cartilage softening. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Cartilage stiffness of 50 patients undergoing anterior cruciate ligament reconstructive surgery because of symptomatic knee instability after chronic anterior cruciate ligament rupture was measured with an arthroscopic indenter device, and the number and size of cartilage lesions were evaluated. RESULTS: The cartilage stiffness did not correlate with time from trauma to surgery (r = 0.002, P = .99), but the number of cartilage lesions in the knee increased when the time from the initial trauma to reconstructive surgery increased (r = 0.356, P = .011). Indentation values measured on healthy-looking cartilage on damaged joint surfaces were lower than the values measured on healthy joint surfaces (P < .01 on lateral femoral condyle and on tibial plateaus). CONCLUSIONS: The number of cartilage lesions increases with increased time after initial trauma. The arthroscopic indenter device is able to detect cartilage softening as the early mechanical sign of degradation not yet visible to the eye.     

Muscle injuries: biology and treatment

Muscle injuries are one of the most common traumas occurring in sports. Despite their clinical importance, few clinical studies exist on the treatment of these traumas. Thus, the current treatment principles of muscle injuries have either been derived from experimental studies or been tested only empirically. Although nonoperative treatment results in good functional outcomes in the majority of athletes with muscle injuries, the consequences of failed treatment can be very dramatic, possibly postponing an athlete's return to sports for weeks or even months. Moreover, the recognition of some basic principles of skeletal muscle regeneration and healing processes can considerably help in both avoiding the imminent dangers and accelerating the return to competition. Accordingly, in this review, the authors have summarized the prevailing understanding on the biology of muscle regeneration. Furthermore, they have reviewed the existing data on the different treatment modalities (such as medication, therapeutic ultrasound, physical therapy) thought to influence the healing of injured skeletal muscle. In the end, they extend these findings to clinical practice in an attempt to propose an evidence-based approach for the diagnosis and optimal treatment of skeletal muscle injuries.